Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway

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Abstract

Objective

To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway.

Design

A cross-sectional study of consultations at several time points.

Setting

The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway.

Subjects

Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions.

Main outcome measures

Manchester Triage System urgency level at presentation, and hospitalization.

Results

Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents.

Conclusion

Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.

Key points

Restricted access to primary care may increase the use of primary care facilities intended for emergency care.
A considerable proportion of the consultations with undocumented migrant women at the emergency primary care services are related to pregnancy.
Consultations with pregnant undocumented migrants more often contained severe pregnancy-related conditions compared to consultations with pregnant residents of Norway.
Interventions to increase access to primary care for pregnant undocumented migrants are urgently needed.

Related collections

Most cited references 31

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Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

Hogne Sandvik, Øystein Hetlevik, Jesper Blinkenberg … (2021)

Background Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. Aim To analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospital admission, and mortality. Design and setting Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs. Method Duration of RGP–patient relationship was used as explanatory variable for the use of OOH services, acute hospital admission, and mortality in 2018. Several patient-related and RGP-related covariates were included in the analyses by individual linking to high-quality national registries. Duration of RGP–patient relationship was categorised as 1, 2–3, 4–5, 6–10, 11–15, or >15 years. Results are given as adjusted odds ratio (OR) with 95% confidence intervals (CI) resulting from multilevel logistic regression analyses. Results Compared with a 1-year RGP–patient relationship, the OR for use of OOH services decreased gradually from 0.87 (95% CI = 0.86 to 0.88) after 2–3 years’ duration to 0.70 (95% CI = 0.69 to 0.71) after >15 years. OR for acute hospital admission decreased gradually from 0.88 (95% CI = 0.86 to 0.90) after 2–3 years’ duration to 0.72 (95% CI = 0.70 to 0.73) after >15 years. OR for dying decreased gradually from 0.92 (95% CI = 0.86 to 0.98) after 2–3 years’ duration, to 0.75 (95% CI = 0.70 to 0.80) after an RGP–patient relationship of >15 years. Conclusion Length of RGP–patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality. The presence of a dose–response relationship between continuity and these outcomes indicates that the associations are causal.

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A systematic review on the use of healthcare services by undocumented migrants in Europe

Marjolein Winters, Bernd Rechel, Lea de Jong … (2018)

Background Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe. Methods The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007–2017. Results A total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services. Conclusions Although it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services. Electronic supplementary material The online version of this article (10.1186/s12913-018-2838-y) contains supplementary material, which is available to authorized users.

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Under-attending free antenatal care is associated with adverse pregnancy outcomes

Kaisa Raatikainen, Nonna Heiskanen, Seppo Heinonen (2007)

Background Most pertinent studies of inadequate antenatal care concentrate on the risk profile of women booking late or not booking at all to antenatal care. The objective of this study was to assess the outcome of pregnancies when free and easily accessible antenatal care has been either totally lacking or low in number of visits. Methods This is a hospital register based cohort study of pregnancies treated in Kuopio University Hospital, Finland, in 1989 – 2001. Pregnancy outcomes of women having low numbers (1–5) of antenatal care visits (n = 207) and no antenatal care visits (n = 270) were compared with women having 6–18 antenatal visits (n = 23137). Main outcome measures were: Low birth weight, fetal death, neonatal death. Adverse pregnancy outcomes were controlled for confounding factors (adjusted odds ratios, OR: s) in multiple logistic regression models. Results Of the analyzed pregnant population, 1.0% had no antenatal care visits and 0.77% had 1–5 visits. Under- or non-attendance associated with social and health behavioral risk factors: unmarried status, lower educational level, young maternal age, smoking and alcohol use. Chorio-amnionitis or placental abruptions were more common complications of pregnancies of women avoiding antenatal care, and pregnancy outcome was impaired. After logistic regression analyses, controlling for confounding, there were significantly more low birth weight infants in under- and non-attenders (OR:s with 95% CI:s: 9.18 (6.65–12.68) and 5.46 (3.90–7.65), respectively) more fetal deaths (OR:s 12.05 (5.95–24.40) and 5.19 (2.04–13.22), respectively) and more neonatal deaths (OR:s 10.03 (3.85–26.13) and 8.66 (3.59–20.86), respectively). Conclusion Even when birth takes place in hospital, non- or under-attendance at antenatal care carries a substantially elevated risk of severe adverse pregnancy outcome. Underlying adverse health behavior and possible abuse indicate close surveillance of the newborn.

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Author and article information

Journal

Journal ID (nlm-ta): Scand J Prim Health Care

Journal ID (iso-abbrev): Scand J Prim Health Care

Title: Scandinavian Journal of Primary Health Care

Publisher: Taylor & Francis

ISSN (Print): 0281-3432

ISSN (Electronic): 1502-7724

Publication date (Electronic, pub): 24 July 2023

Publication date (Electronic, collection): 2023

Publication date PMC-release: 24 July 2023

Volume: 41

Issue: 3

Pages: 317-325

Affiliations

[a ]Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo , Oslo, Norway

[b ]Department of General Practice, Institute of Health and Society, University of Oslo , Oslo, Norway

[c ]Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency , Oslo, Norway

[d ]Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital , Oslo, Norway

Author notes

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02813432.2023.2237074.

CONTACT Frode Eick frode.eick@ 123456medisin.uio.no Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo , Postboks 1130 Blindern, 0318 Oslo, Norway

Article

Publisher ID: 2237074

DOI: 10.1080/02813432.2023.2237074

PMC ID: 10478594

PubMed ID: 37485974

SO-VID: 23a53aca-fd82-4a8f-909a-d736012e0a18

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway

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Abstract

Objective

Design

Setting

Subjects

Main outcome measures

Results

Conclusion

Key points

Related collections

50 years of ROAPE

Most cited references 31

Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

A systematic review on the use of healthcare services by undocumented migrants in Europe

Under-attending free antenatal care is associated with adverse pregnancy outcomes

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